Invisible Wounds

When Jeff Miller returned from Saudi Arabia in 2003, he jumped feet first back into society. The staff sergeant and security forces specialist with the 363rd expeditionary security forces squadron did everything expected of him: got married; got a job; had two children.
But something was wrong. He started having nightmares, flash anger — going from mildly irritated to explosively angry in minutes — and problems being in crowded places.
“Over the first year or so, my wife would say, ‘Gosh, you know you’ve got some anxiety, some separation issues,’ particularly with crowds,” says Miller, who until recently was the state legislative chairman for Veterans of Foreign Wars. “I didn’t want to go to a mall, or movie, or party … “
“I thought, that’s just me being me,” he says by phone from his Bellevue home, his voice revealing a deep conviction. “It took me almost seven years to recognize that I was actually being affected by PTSD.”
Across the country, alternative methods for treating PTSD are being explored and studied, including meditation, yoga and breathing exercises, as soldiers and health practitioners alike find standard treatments lacking.
Rates of post-traumatic stress disorder, suicide and depression have jumped for American soldiers in recent years. Studies estimate as many as 1 in 5 veterans will have PTSD at some point in their lives, compared to 1 in 10 for Gulf War veterans. The number skyrockets to nearly 1 in 3 for veterans of the Vietnam War.
Among all Americans, about 1 in 14 people will have PTSD at some point, according to the U.S. Department of Defense.
Symptoms of post-traumatic stress disorder include flashbacks; bad dreams or sleep troubles; feeling guilt, depression or being emotionally numb; losing interest in activities that were enjoyable in the past; being easily startled, or on edge; and angry outbursts, according to the National Institute of Mental Health.
The VA Nebraska-Western Iowa Health Care System cared for nearly 6,000 veterans in 2010, says public affairs officer William Ackerman. About 2,600 of those were veterans from Operation Iraqi Freedom and Operation Enduring Freedom. The Omaha VA spent $535,201 in 2010 treating 1,001 PTSD patients, according to information obtained by The Reader through a Freedom of Information Act request. That’s the highest number of patients in the last eight years, and almost double the 586 patients who received care in 2002, the earliest data available.
And the consequences of such numbers can be shocking: Last year, for the first time, more U.S. service members took their lives than were killed by hostile forces.
The pain of surviving
Fifty-three soldiers from Nebraska have died in the wars in Afghanistan and Iraq, including nine from Omaha, according to the Washington Post ’s “Faces of the Fallen” online database.
For those who survive, however, readjusting to civilian life can be difficult — even something as basic as getting rest. From 2008, the earliest data available, to 2010, the number of Omaha VA patients receiving medicine to help them sleep catapulted from 19 to 1,001.
Many veterans and counselors hope therapies such as yoga and animal companionship could help turn the tide. It’s hard to determine the extent to which alternative treatment for PTSD is used, but researchers say it’s definitely a trend.
“Anecdotally, we hear this more and more, that more (Department of Veterans Affairs) programs are offering programs such as pet therapy, equestrian therapy, yoga, tai chi, acupuncture,” says Paula Schnurr, deputy executive director of the U.S. Department of Veterans Affairs National Center for PTSD.
The VA is preparing a survey to find out exactly how many veterans are engaged in these practices. It hopes to learn if treatments help those with PTSD and depression, which occur at roughly the same rates in veterans, and often overlap, she says.
Yoga, in particular, has proven popular.
Sean Bradrick has been teaching yoga for 25 years. For the last two or three, he’s contracted with the Omaha Veterans Affairs Medical Center to teach meditation and relaxation techniques to veterans.
“It’s not just for PTSD, but for people with depression, people with schizophrenia, bipolar disorder,” he says. “It’s so good for so many mental and physical ailments.”
And at this point, the military is willing to try anything, as the impact of PTSD and depression grows: From 2007 to 2010, suicides in the army more than doubled.
In June of this year, the number of confirmed or suspected suicides for the army alone reached one every 22.5 hours. Through November, the army has recorded 268 confirmed or suspected suicides in 2010 among both active and non-active duty personnel — up from 245 in all of 2009, 197 in 2008 and 115 in 2007.
The Omaha VA doesn’t keep track of suicides for military personnel stationed in Nebraska, but the number of unique patients who visited its mental health facility rose 37 percent from the fiscal year 2002 to the fiscal year 2010 — from 5,614 to 8,832.
How alternative techniques work
“We understand that these practices are important to our veterans, and we have an important need for knowledge about how widely they’re being used,” Schnurr says. “We also need to know how they work or what they work for.”
The only practice shown in definitive trials to have benefits for directly treating PTSD is acupuncture, she says, though early open trials regarding mindfulness components, such as meditation and breathing techniques, “look encouraging.”
“It comes from the Buddhist practice of living in the present,” she says. “Oftentimes, when people have depression or PTSD or other problems, they’re very much stuck worrying about the past or worrying about the future, and spend a lot of time and a lot of emotional energy on things that have already happened or things that have not yet happened.”
Mindfulness practices teach people to live in the moment. They teach acceptance, preparation and how to deal with the present.
“Sounds kind of logical, right? Everyone should do that. But we don’t,” Schnurr says. “We spend too much time thinking about things we can’t control.”
While data isn’t available to show effectiveness of more physical practices like yoga or tai chi, Bradrick says soldiers he’s instructed have received enormous benefit.
“It’s based on using yoga as exercise for the body and using mediation as an exercise for the mind,” he says. “Everyone has anxiety; Gandhi had anxiety. But when anxiety reaches the level of PTSD … that’s where yoga and mediation can be used as a form of therapy, rather than just a superficial physical exercise.”
For example, hearing sirens might trigger a panic attack in an individual, leading to anxiety, leading to a worse panic attack the next time. But through yoga and breathing techniques, Bradrick says that person can learn to control his or her anxiety by learning to still his or her mind, breath and heartbeat.
Some have called it a gift — others, a powerful medicine.
“Everyone’s different, of course, but generally speaking, I have probably a 90 percent rate of people that say by the end of the session that they feel like their anxiety and that their PTSD is much more manageable,” Bradrick says. “They feel like they have some control over it, where at the beginning they felt helpless to it.
“I’ve never had someone who’s made it through a whole session come up and say, ‘Hey, I feel worse than I did before I learned all this stuff.’”
Focusing on the present
At Ease is a program for traumatized veterans started this year by Lutheran Family Services of Nebraska. So far, they’ve worked with 53 people, including service members and their families. Twenty-five percent of the soldiers fought in the Iraq and Afghanistan wars. A “significant portion” served during the Vietnam War.
Program supervisor Debra Jones says At Ease encourages a family-based, holistic approach to PTSD, teaching coping skills and relaxation techniques.
“We don’t use yoga, because at the point clients are coming to us, their trauma is recent and significant and they don’t care to be touched,” she says. “Initially, one of the issues is that most of the returning combat veterans that are struggling with PTSD don’t feel safe anywhere. So we encourage them to identify and construct a safe place.”
Miller was recommended to At Ease by a private doctor, and he says meeting with a therapist has been “the greatest relief of my life since returning back from the Middle East.” He’s also practiced awareness and breathing techniques to help with his anger, saying they “definitely work.”
“That split second when a veteran has the opportunity to react to a situation … that split second of decision-making, what I’ve done is essentially take myself out of the equation for two seconds and really think about what’s important,” Miller says. “You take a very simple process and break it down. … It’s allowed me to process that info at face value, instead of lumping other things into it.”
It’s also allowed him to control his anger flashes, he says, bringing himself down from a 9 or 10 on a scale of 10 down to a 4 or 5. At Ease also collaborates with Omaha’s Take Flight Farms, which offers equine-based therapy and pet therapy.
“Anything, whether it be another human being or an animal, that a veteran can make a connection with is critical in the first phase of reestablishing trust and safety,” Jones says.
Drugs still dominate PTSD treatments
Interest in alternative methods has increased for numerous reasons, experts say: for many, there’s little to no risk of side affects; treatments are non-invasive; and they’re done by the patient, instead of to the patient.
“There’s also an increasing emphasis on wellness, and many of these techniques are really about the idea of not reducing a disorder, but about living and staying well, increasing your quality of life,” says Schnurr with the National Center for PTSD. “Practices that are more physical may also be more appealing to younger veterans, because anecdotally, we know that many younger veterans are very involved in physical fitness activities.”
And many who don’t have criteria for depression or PTSD might still have adjustment difficulties, Schnurr says.
“My guess is that many of them are people who, even if they don’t have a disorder, want or need some help,” she says. “They notice a difference between now and before they were deployed.”
But experts stress that yoga, breathing techniques and other alternative remedies should not replace psychiatric or psychological therapy.
“These are not primary interventions,” Schnurr says. “These are helpful secondary interventions that may improve your quality of life. They may improve your sleep. They may improve how you feel about yourself.”
Bradrick agrees.
“I would never say, ‘Oh, do yoga and someday you won’t need drugs,’” he says. “Yoga and meditation can work alongside osteopathic psychiatry and biochemical drugs.”
At the Omaha VA, soldiers received 108,671 prescriptions in 2010 for antidepressant or antipsychotic drugs. That’s a decrease from 2009’s high of 116,670 prescriptions, but it’s still 78 percent higher than the 61,093 prescriptions given in 2000.
But painkiller prescriptions have dropped off considerably, from a 2001 high of 126,774. They rose again slightly, from 2005 to 2009, reaching 97,389, but decreased again last year.
Veterans also need to keep in mind that methods like acupuncture and tai chi are still being studied, Schnurr says.
“It’s very understandable that people are seeking out these techniques. It’s just important for them to be informed consumers,” she says. “Evidence about how they work and how well they work is still coming in.”
But despite the uncertainty surrounding these methods, more and more soldiers are eager to try them.
“There’s so much energy and interest, and I think good scientist are designing good studies to look at these things,” Schnurr says. “It’s a very exciting time.”
And it can’t happen too soon, Miller says. Throughout the interview, he’s grown more contemplative, well aware of the toll PTSD can have on an individual.
“Not all wounds are visible,” Miller says. “Wounds in a person’s soul or head can take a long time to heal … But (soldiers) might surprise themselves what they can find, what peace.”